Update on the Senate’s efforts to Repeal parts of the ACA

After releasing the Better Care Reconciliation Act at the end of last week, leadership in the U.S. Senate announced this week that it will not be voting on the bill before the July 4th Congressional recess as planned. Instead efforts are underway to overhaul the bill, with a vote is expected sometime after the recess. Senate Majority Leader Mitch McConnell has said that he intends to submit a new version of the bill to be scored by the Congressional Budget Office today.

Prior to announcement that the Senate would go back to the drawing board, our health policy experts analyzed the bill. The following is an overview of the key provisions that had been proposed and may be included in the next version of the bill:

Key Medicaid Provisions
  • A transition of federal funding of Medicaid to per capita caps or block grants;
  • A phase out of enhanced federal funding for the Medicaid expansion population;
  • An increase in Medicaid Disproportionate Share Hospital allotments for non-expansion states and additional funding for safety-net providers in those states;
  • A repeal of the Essential Health Benefit requirement under Medicaid;
  • Flexibility for states to institute work requirements for Medicaid eligibility;
  • A repeal of presumptive eligibility determinations and retroactive eligibility;
  • A gradual reduction in states’ ability to use provider taxes to generate revenue to finance Medicaid; and
  • Additional flexibility with respect to Medicaid coverage of inpatient stays in Institutions for Mental Diseases.

Key Private Insurance Provisions
  • A reduction in eligibility for Premium Tax Credits to a maximum of 350% of the Federal Poverty Level (FPL) and making those below 100% FPL who are not eligible for Medicaid eligible;
  • An increase in the required personal contribution before Premium Tax Credits for older individuals and a decrease younger individuals, and basing premium Tax Credits on the premiums for skinnier plans;
  • Guaranteed payments of Cost-Sharing Reductions through 2019 and then repeal;
  • A repeal of the small business premium tax credits;
  • A repeal of the individual and large employer mandates;
  • Restricting coverage for abortions;
  • An expansion of age bands for premiums and eliminating federal standards for Medical Loss Ratios or the limit on insurer administrative spending;
  • Making it easier for states to waive provisions of the ACA; 
  • Creation of a short term market stabilization fund to make payments to insurers and a long term fund for state market stabilization efforts; 
  • Authorizing Association Health Plans that are not subject to state regulation for small employers; 
  • Expanding use of Health Savings Accounts and similar accounts; and
  • An amendment proposed waiting periods for individuals who do not maintain continuous health care coverage.

  • Creation of an implementation fund and grants for state efforts to curb Substance Use Disorders; elimination of the Prevention and Public Health Fund; and additional funding for Community Health Centers;
  • A one-year prohibition on funding to Planned Parenthood.

  • Repealing and decreasing ACA taxes and other tax changes.

Members of the HIPIT team are monitoring for the new bill and will share more information once it is available.